角袋注射技术对锁骨上臂丛神经阻滞后膈肌麻痹的影响

Effect of corner pocket injection technique on supraclavicular brachial plexus obstruction and diaphragmatic paralysis

目的分析角袋注射技术的临床疗效及对锁骨上臂丛神经阻滞后膈肌麻痹的影响。方法选择2020年1月至2021年12月于沧州市人民医院诊治的需在臂丛神经阻滞麻醉下行手术患者80例,其中男性52例,女性28例;年龄20~40岁,平均年龄30.46岁;身体质量指数(BMI)17.42~28.01 kg/m^(2),平均BMI 22.51 kg/m^(2);美国麻醉医师协会(ASA)分级Ⅰ级24例,Ⅱ级40例,Ⅲ级16例;手术部位,肘部24例,前臂21例,手腕27例,手8例。随机分为试验组(n=40例)及对照组(n=40例)。对照组予传统神经丛周围阻滞麻醉,试验组则采用超声引导角袋注射技术进行麻醉。对两组患者麻醉前和麻醉后30 min平静呼吸膈肌移动度及肺功能指标进行比较。比较两组患者膈肌麻痹发生率及并发症;以患者阻滞后30 min是否出现膈肌麻痹为终点,对两组患者阻滞后30 min用力呼吸膈肌移动度与膈肌麻痹发生风险进行比较。结果试验组麻醉效果为优良率的患者明显高于对照组[92.5%(37/40)vs 70%(28/40)。P<0.05]。感觉及运动阻滞起效时间显著低于对照组[(5.41±1.09)min vs(6.84±1.65)min、(9.06±1.27)min vs(11.98±2.71)min],而持续时间显著高于对照组[(404.96±89.73)min vs(11.98±2.71)min、(417.93±91.78)min vs(300.86±51.92)min](均P<0.05);阻滞后试验组患者的膈肌移动度及肺功能指标均显著高于对照组(P<0.05)。试验组患者膈肌麻痹发生率及并发症发生率明显低于对照组[(12.5%(5/40)vs 37.5%(15/40),7.5%(3/40)vs 25%(10/40)。均P<0.05]。以出现膈肌麻痹为终点,试验组膈肌活动度大于对照组,膈肌麻痹发生风险延后对照组(P<0.05)。结论角袋注射技术麻醉效果优于传统神经丛周围阻滞麻醉,且对膈肌麻痹的影响较小,术后不良反应少。

Objective To analyze the clinical efficacy of corner pocket injection technique and its effect on diaphragmatic paralysis after supraclavicular brachial plexus block.Methods From January 2020 to December 2021,a total of 80 patients performed operation under brachial plexus block anesthesia were enrolled,which included 52 males and 28 females,aged 20-40 years old with mean age of 30.46 years old;body mass index(BMI)was 17.42-28.01 kg/m^(2) with mean BMI of 22.51 kg/m^(2).According to American Society of Anesthesiologists(ASA),there were 24 cases of gradeⅠ,40 of gradeⅡ,and 16 of gradeⅢ.The operations were performed on elbow in 24 cases,forearm in 21,wrist in 27 and hand in 8.All of them were randomly divided into experimental group(n=40)and control group(n=40).The control group was anesthetized by traditional nerve plexus block,while experimental group was anesthetized by ultrasonic-guided corner pocket injection technology.The diaphragmatic mobility and pulmonary function indexes of 2 groups before anesthesia and 30 minute post anesthesia were compared,and the incidence of diaphragmatic paralysis and complications between 2 groups were compared.The diaphragmatic paralysis at 30-minute after block was set as the terminal;the diaphragmatic mobility and risk of diaphragmatic paralysis at 30-minute after block between 2 groups were compared.Results The excellent rate of anesthesia in experimental group was significantly higher than that in control group[92.5%(37/40)vs 70%(28/40).P<0.05].The onset time of sensory and motor block were significantly shorter than those of control group[(5.41±1.09)minutes vs(6.84±1.65)minutes,(9.06±1.27)minutes vs(11.98±2.71)minutes],but the durations were significantly longer than those of control group[(404.96±89.73)minutes vs(11.98±2.71)minutes,(417.93±91.78)minutes vs(300.86±51.92)minutes](P<0.05).After block,the diaphragm mobility and pulmonary function indexes of experimental group were statistically significantly higher than those of control group(P<0.05).The incidence of diaphragmatic paralysis and complications in experimental group were significantly lower than those in control group[12.5%(5/40)vs 37.5%(15/40),7.5%(3/40)vs 25%(10/40).P<0.05].The diaphragmatic paralysis was set as the terminal,the diaphragm activity of experimental group was greater than that of control group,and risk of diaphragmatic paralysis was delayed in control group(P<0.05).Conclusion It is demonstrated that the anesthesia effect of corner pocket injection technique is better than that of traditional nerve plexus block anesthesia,which has little side effect on diaphragmatic paralysis and less postoperative adverse reaction.